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Stories from SlateAmazon’s Illegal Drug Dealinghttp://www.slate.com/articles/health_and_science/medical_examiner/2014/05/amazon_illegal_drugs_muscle_relaxants_steroids_prescription_drugs_delivered.html
<p>My wife Lisa doesn’t cherish the fact that this story begins by disclosing her recent acne flare-up. But given the wider public health implications, she’s given me permission to write about the stubborn collection of pimples on her left cheek that didn’t respond to her usual skin care. It is, after all, the problem that led to a prescription drug arriving on our doorstep a couple of weeks ago without a prescription. A drug she’d purchased from one of America’s largest retailers, Amazon.</p>
<p>Lisa wasn’t searching the dark alleys of the Internet for something illicit. While she was scrolling through the acne treatments available on Amazon, where she rocks her Prime account like a boss, the site served her up something she wasn’t looking for and didn’t know she wanted, an acne treatment called <a href="http://www.amazon.com/Vitara-Clinda-Treats-Acne-Pimples/dp/B00EAMR8EK/">Vitara Clinda Gel</a>. Several happy Amazon customers had raved about it in five-star reviews. But once her purchase arrived from a third-party seller in Thailand with “Gift” scrawled across the customs declaration tag, she got suspicious. Then she read the label. “Hey isn’t clindamycin a prescription drug?” she asked me, a physician.&nbsp;</p>
<p>Clindamycin is indeed a prescription-only antibiotic that we don’t use lightly even in the hospital, where it’s known to set off potentially deadly Clostridium difficile diarrhea after killing good gut bacteria, and it sometimes provokes a severe allergic skin reaction called Stevens–Johnson Syndrome. It’s available as a prescription gel for tough acne vulgaris infections, but it’s something I’d leave to the dermatologists and wouldn’t prescribe to someone like my wife for a few pimples. So how’d she get it so easily from Amazon?&nbsp;</p>
<p>I have by no means executed a comprehensive search of wares sold by Amazon directly or through its third-party sellers, but I found other prescription drugs for sale without a prescription, including the antibiotic <a href="http://www.amazon.com/Norxacin-antibacterial-uncomplicated-complicated-infection/dp/B00FG1OLNK">norfloxacin</a> and the muscle relaxant <a href="http://www.amazon.com/Platinum-Muscle-Relaxant-Analgesic-Caplets/dp/B00HSZDN1I/">methocarbamol</a>. Both compounds, like clindamycin, warrant careful oversight to avoid complications or endangering public health, such as by breeding antibiotic resistance. Methocarbamol, which causes a mild high, can be abused and can prove deadly when mixed with alcohol. Selling these drugs without a pharmacy license and without a prescription is flat out illegal.&nbsp;</p>
<p>Which is precisely what the FDA and U.S. Customs and Border Protection had in mind last week when their agents descended on international mail facilities in Los Angeles, New York, and Chicago, seizing hundreds of packages containing <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm398499.htm">illegally distributed prescription drugs</a> on their way to American consumers. The FDA also found 1,975 websites illegally selling medications to U.S. consumers as part of “Operation Pangea VII,” an international effort coordinated by Interpol. The agency sent Internet service providers warning notices about the illegal activities taking place on their servers.&nbsp;</p>
<p>The FDA didn’t respond to questions about whether any of the seized goods were purchased via <a href="http://amazon.com/">Amazon</a>. Last year CBP intercepted 4,821 packages containing medications illegally imported by Americans without prescriptions at international mail facilities across the country, the agency told me. It conducts its enforcement operations in conjunction with FDA and the Department of Homeland Security. The numbers represent a drop in the ocean.&nbsp;</p>
<p>The type of illegal drug sales on Amazon happens to be well suited for avoiding CBP scrutiny, says <a href="http://www.cassidylevy.com/people/james-r-cannon-jr">James Cannon</a>, president of the <a href="http://www.citba.org/index.php">Customs and International Trade Bar Association</a>, who spoke with me in his capacity as a partner with Cassidy Levy Kent, a top international trade law firm. “They know they’re going through these massive distribution centers where carriers bring everything in the middle of the night and there’s so much volume it’s very difficult to look at everything. Customs inspects, but it’s more like random sampling,” Cannon told me. Enforcement would work better if there were a “whistle-blower” that called attention to it, and then CBP could go specifically looking.&nbsp;</p>
<p>CBP likely wouldn’t prosecute the individual American consumer, who might not even understand they’d made an unlawful transaction, Cannon adds. The target would need to be Amazon, which created and profits from its marketplace connecting consumers to illegal medical products from around the world. In the case of the clindamycin my wife received from Thailand, Amazon <a href="http://services.amazon.com/selling/pricing.htm">made 15 percent off the sale</a>.</p>
<p>Which federal agency has responsibility for policing Amazon? CBP operates on the ground in shipping facilities and ports. Investigating Amazon’s business practices would be up to the FDA, and that agency would then direct CBP to take any necessary actions on its turf.&nbsp;</p>
<p>I spoke with <a href="http://www.morganlewis.com/bios/gyingling">Gary Yingling</a>, a former FDA attorney who is now a partner with megafirm Morgan Lewis. “In my view there’s no question FDA has jurisdiction because you’re talking about a prescription drug and you’re talking about importing it into the United States,” Yingling says. He points out that FDA has limited resources, and violations are everywhere. A more typical joint FDA and CBP action occurred with one of Cannon’s clients, a multibillion-dollar pharmaceutical company with a factory in Germany. CBP seized one of the German factory’s large U.S. shipments because the factory’s FDA-issued manufacturing license had expired. This was an easy spot for the FDA to flex its muscle: halting a declared shipment on an established trade route from a registered factory. It’s far more difficult, and even impractical, to intercept shipments from all over the world to tens of thousands of individual consumers.&nbsp;</p>
<p>In order to slow this trade, the FDA would have to target a major player in the complex shipping network, Amazon, by issuing a secret “untitled letter” or a public “warning letter” to Amazon CEO Jeff Bezos. In response to questions about Amazon, the FDA replied to me that Amazon has been the subject of consumer complaints, but that it has not been “the subject of any warning letter or enforcement action.” The FDA did not explain why Amazon has not come under publicly revealed scrutiny and declined to comment on whether Amazon has been the subject of untitled letters, which are not public.</p>
<p>Yingling notes that the FDA must be ready to engage in a fierce legal battle, as “Amazon’s not going to be willing to change their business instantaneously just because I’m the FDA.” The teeth backing up those letters is the threat to seek a court-ordered injunction against the business model, which could lead to a consent decree forcing Amazon to change its business permanently.</p>
<p>So why does Amazon risk such disruptive and expensive government action that could rock its stock price? A look at the company’s longstanding, profitable business selling anabolic steroids sheds some light on Amazon’s apparent feeling of invincibility. The FDA seems to have a blind spot for the online commerce champion. The agency overlooked sales of the same dangerous products on Amazon when <a href="http://www.fda.gov/ICECI/CriminalInvestigations/ucm305494.htm">it went after BodyBuilding.com</a> for anabolic steroids in 2012, according to Oliver Catlin, CEO of the Banned Substances Control Group, which tests commercially available supplements for illicit compounds banned in sports, such as anabolic steroids. Catlin provided <strong><em>Slate</em></strong> with screenshots he took of Amazon products dating back to 2010, two years before the FDA levied a $7 million fine against BodyBuilding.com and a separate $600,000 fine against its president. The screenshots reveal Amazon selling M-Drol in 2010, 2011, 2012, and 2013 and P-Plex in 2012, two of the <a href="http://www.fda.gov/safety/recalls/ucm188929.htm">steroids</a> that led the FDA to crack down on BodyBuilding.com.&nbsp;</p>
<p>When BSCG discovered anabolic steroids for sale to anyone on Amazon back in 2011, the <em>Washington Post</em> <a href="http://www.washingtonpost.com/wp-dyn/content/article/2011/01/19/AR2011011900004.html">reported on its findings</a>. Catlin now admits he was naive to think the company would change its ways. “Frankly we’ve been looking behind the scenes for a while and it really bothers me there’s no action,” he says. “From my perspective, for the FDA to go after a distributor the size of BodyBuilding.com and close down that outlet and then leave open America’s largest distributor to sell the very same products is a complete hypocritical application of the law.” He watched dumbfounded as steroid products BSCG had tested and reported in 2011 reappeared on Amazon months later. He now sees little point in continuing the expense of buying and testing the products when the makers boldly list their ingredients. After <em>Forbes</em> picked up BSCG’s most recent report in last fall about the <a href="http://www.forbes.com/sites/alexmorrell/2013/10/26/steroids-for-sale-online-at-amazon-and-sears/">continuing availability of anabolic steroids on Amazon</a>, the company again removed the products he’d highlighted.&nbsp;</p>
<p>I asked Catlin to check if Amazon has allowed the products back yet again. Sure enough, Amazon continues selling dangerous steroids and stimulants banned in sports and at least one drug regulated by the DEA, <a href="http://www.amazon.com/CEL-M-D-90-Capsules/dp/B00K2YNENO/">M-Drol</a>, which contains the anabolic steroid methasterone. It is illegal to sell methasterone without a prescription and a DEA license. The <a href="http://www.deadiversion.usdoj.gov/fed_regs/rules/2011/fr1123.htm">DEA warned about methasterone</a> in 2011, and this specific product <a href="http://www.competitiveedgelabs.com/cel-recall-notice/">has been recalled</a>, yet it keeps making its way back onto Amazon. Amazon also trades in many compounds that are dangerous to the human body and banned by anti-doping agencies but aren’t yet illegal. One example is trenavar, marketed as <a href="http://www.amazon.com/TR3N-by-Olympus-Labs-90ct/dp/B00G98NLW6">TR3N</a>, which is a “prohormone” that the body converts into another active compound. That compound is trenbolone, a DEA-controlled anabolic steroid. There’s nothing unusual about prodrugs as pharmaceuticals. We use many prescription prodrugs in daily medical practice, all regulated by the FDA, that become active only when <a href="http://en.m.wikipedia.org/wiki/Category:Prodrugs">processed inside the human body</a>. That the DEA can’t easily regulate prodrugs of scheduled substances like trenbolone is simply an artifact of the outdated legislation that created the agency.&nbsp;</p>
<p>That’s a situation Sens. Sheldon Whitehouse and Orrin Hatch hope to change with the bipartisan <a href="http://beta.congress.gov/bill/113th-congress/senate-bill/2012">Designer Anabolic Steroid Control Act of 2014</a>. The legislation promises to modernize the DEA’s governing rules by empowering it to respond to the exploding supplement industry, which has realized enormous profits by slightly tweaking controlled and prescription-only compounds to elude enforcement. These designer drugs are being marketed on outlets like Amazon before the DEA and FDA can react. “Right now, in order to classify new substances as steroids, the DEA must complete a burdensome and time-consuming series of chemical and pharmacological testing,” Sen. Whitehouse told me. He says the law would permit DEA to temporarily schedule new designer steroids as controlled substances, proactively protecting consumers from companies that are exploiting a loophole in current law.&nbsp;</p>
<p>Yet Amazon is already selling prescription drugs and at least one scheduled substance in violation of current laws. It's unclear whether the new bill will do anything more than add to a growing list of unlawful commerce on the site, should it generate similar respect as current law. If the DEA and FDA only conduct flashy package intercepts like Operation Pangea, they won't be doing much to stop the root problem, the Amazon marketplace itself. Yet unlike some of the fly-by-night companies federal agencies have targeted in the past, Amazon is listed on the NASDAQ. It has the capacity to reform its business model and operate on the straight and narrow.</p>
<p>The Center for Safe Internet Pharmacies represents a coalition of payment processors, shippers, and online service providers including Google, UPS, Visa, and MasterCard that all understand their platforms are <a href="http://www.safemedsonline.org">being used for illegal pharmaceutical commerce</a>. The organization believes that by banding together and sharing strategies to combat this criminal activity, they’re an important complement to the work of the FDA and DEA. The organization provides consumers a <a href="http://www.safemedsonline.org/protecting-consumers/check-your-pharmacy/">searchable database</a> to check if a given website is a legal pharmacy. It shouldn’t surprise readers at this point that Amazon is not listed. The organization is proud of the fact that last year alone its member companies blocked or removed more than 5 million websites that illegally distribute prescription drugs, says Marjorie Clifton, CSIP’s executive director. “We want and invite companies like Amazon to join us,” Clifton says, adding that for Amazon to do so it will need to “sign on to a principles of participation document that outlines how our member companies interact in this space.” She wants Amazon to know that it is not alone in coming to terms with the fact that their platform is facilitating illegal drug sales. “All our partners have had to face this at one time or another.”</p>
<p>I asked Amazon public relations manager Erik Fairleigh a number of specific questions about how illegal products make it through to the site to end up being sold to Amazon customers. I wanted to know if Amazon employees manually review each product before it is listed, why products are removed following reporting like this only to reappear later on the site, and if Amazon considers itself protected from liability when third-party distributors are selling illegal products to Amazon’s customers. Fairleigh declined to answer these questions, but he did point me to Amazon’s <a href="http://www.amazon.com/gp/help/customer/display.html/ref=help_search_1-1?ie=UTF8&amp;nodeId=201166010&amp;qid=1384386102&amp;sr=1-1">policy on counterfeiting</a>, which attempts to distance the company from the third-party sellers in its marketplace by saying “it is each seller’s responsibility to source and sell only authentic products.” The policy goes on to state that, “if we determine that a seller account has been used to engage in fraud or other illegal activity, remittances and payments may be withheld or forfeited.”</p>
<p>Thanks to work by people like Oliver Catlin, organizations like CSIP, and FDA actions against companies like BodyBuilding.com, Amazon is well aware that it operates a marketplace where illegal drugs are sold to American consumers. This report adds prescription antibiotics and muscle relaxants to the mix. The inaction of Amazon itself may be easier to explain than the inaction of federal regulators. As one of the first successful online businesses, Amazon had no qualms about exploiting a tax loophole that allowed it to sell goods for less than brick-and-mortar stores. It profits enormously from creating a platform for third-party sellers where anything that can be shipped can be sold, and Amazon will react after the fact by removing products or suspending sellers if there’s a serious problem. That strategy makes more sense for an auctioneer like eBay, where the seller handles the transaction, but Amazon’s sellers all have close business relationships with the company, which handles the customer relationship, processes all payments, and charges a percentage of sales that varies with the type of item.&nbsp;</p>
<p>In some cases, like TR3N, Amazon handles fulfillment as well, meaning this legal prodrug of an illegal steroid is shipped direct from an Amazon warehouse. Recently <em>USA Today</em> reported on Dutch research showing that another Amazon item, Dexaprine XR, causes vomiting, chest pain, and elevated heart rates that could be life-threatening due to its <a href="http://www.usatoday.com/story/news/nation/2014/05/09/tests-find-synthetic-stimulants-iforce-nutrition-dexaprine-xr/8905197/">amphetamine-like ingredients</a>. The manufacturer, iForce, pled criminally guilty in 2011 to putting synthetic steroids in its products. You won’t find this product at GNC, but Amazon gladly <a href="http://www.amazon.com/iForce-Nutrition-Dexaprine-Ct-New/dp/B00BLQF336">ships this poison out of its warehouse direct to your doorstep</a>. Just because a product has escaped regulatory scrutiny so far doesn’t mean it’s a good idea to sell it or ingest it.</p>
<p>The blunt way Amazon wields its market dominance is well-known to publishers, <a href="http://mobile.nytimes.com/blogs/bits/2014/05/23/amazon-escalates-its-battle-against-hachette/?_php=true&amp;_type=blogs&amp;hp=&amp;_r=0">especially Hachette</a>. The literary world is up in arms about the way Amazon conducts its book selling business. A <em>New Yorker</em> editor recently tweeted that he made an online purchase via Walmart to “<a href="https://twitter.com/nxthompson/status/470528326810222592">support the underdog</a>.” But a far more serious consequence of the company’s power may be the way it has pushed out local shops run by people who knew what they were selling. Amazon has replaced that quaint notion with a robot-powered emporium that exposes American consumers to a world of dangerous products.&nbsp;</p>Thu, 29 May 2014 12:46:00 GMThttp://www.slate.com/articles/health_and_science/medical_examiner/2014/05/amazon_illegal_drugs_muscle_relaxants_steroids_prescription_drugs_delivered.htmlFord Vox2014-05-29T12:46:00ZSteroids, muscle relaxants, and prescription antibiotics delivered right to your door.Health and ScienceAmazon’s Illegal Drug Dealing: Steroids, Muscle Relaxants, and Prescription Drugs100140529002steroidsAmazondrugsFord VoxMedical Examinerhttp://www.slate.com/articles/health_and_science/medical_examiner/2014/05/amazon_illegal_drugs_muscle_relaxants_steroids_prescription_drugs_delivered.htmlfalsefalsefalseAmazon is selling muscle relaxants, steroids, prescription drugs. Investigation by @FordVoxAmazon’s Illegal Drug Dealing: Steroids, Muscle Relaxants, and Prescription DrugsPhoto Courtesy of ShutterstockSelling certain drugs without a pharmacy license and without a prescription is illegal.State of Mindhttp://www.slate.com/articles/health_and_science/medical_examiner/2009/04/state_of_mind.html
<p> Seventeen months ago, Joshua Hummel, now 24, was sleeping in his Seattle home when someone attacked him with an ax. He survived, but the penetrating blows to his skull left him in a minimally conscious state. Today he lives with his parents and two siblings in a St. Louis suburb. As I talk with his family in the kitchen, Joshua sits next to us in a wheelchair that he can't move himself. After a $17,000 remodel, his wheelchair can fit into the accessible bathroom, but he can't use the handrails on the walls. In the den there's a standing frame—when his mom uses a <a href="http://en.wikipedia.org/wiki/Hoyer_lift">Hoyer lift</a> to transfer him into it, the frame can support his body in a standing position, which is important for his circulation.</p>
<p>As a resident in <a href="http://www.aapmr.org/">physical medicine and rehabilitation</a>, I handle the medical rehabilitation of people after disabling injuries. Severe traumatic brain injuries constitute one of my most challenging ICU consultations. After neurosurgery has saved lives (in Joshua's case, by cutting out portions of skull so that the swelling brain can expand), we're called in to answer the family's burning question: What's the potential for meaningful recovery? Unlike in brain death, where we can look for flat-lined brain waves or the cessation of intracranial blood flow, doctors don't have confirmatory tests for consciousness and its shades of gray. That's one reason studies uncover alarming rates of misdiagnosis of the vegetative state. About one-third of the time, &quot;vegetative&quot; patients are minimally conscious or even better. </p>
<p>Examining these patients can make me feel as if I'm apishly tapping on a black box flight recorder trying to get it to make sounds, cough, sputter, or blink when one day I'll simply plug it into the right data retrieval port, but I believe future clinicians won't view us as barbarians. We know that the location of the brain damage matters, and a surprising amount of brain tissue can be lost before there is no potential for recovery. The mechanism of injury also weighs strongly—losing blood flow to the brain during a heart attack (like Terri Schiavo) can result in a predictably permanent vegetative state.</p>
<p>After a severe brain injury, most patients progress through a familiar <a href="http://www.rancho.org/patient_education/bi_cognition.pdf">series of stages</a>, at times reliving the worst parts of childhood emotional development. But that's if the brain comes back online at all. Directly after the injury, a coma lasting up to two or three weeks ensues, which is somewhat like a deep sleep. Unlike in sleep, however, the brain stem shuts down as well, necessitating life support. Within two to three weeks, patients come off ventilators and begin recovery, or they may enter a vegetative state of unknown duration. Vegetative patients do not react meaningfully to environmental stimuli. If you pinch them, you'll get reflex posturing. They may yawn or grunt; they may briefly stare but cannot sustain the gaze or track movements. Vegetative patients sleep, awaken, and breathe on their own, but they require feeding tubes. </p>
<p>Rather than spontaneously resuming normal consciousness, many vegetative patients enter into another state of mind, the minimally conscious state. MCS patients often fluctuate in and out of the vegetative state, and the only feature that defines their periods of consciousness is some evidence of purposeful behavior, however slight. They might twitch a thumb on command, or their eyes might track someone's movements around the room. Clinicians who oversee patient care in nursing homes can be forgiven for missing subtle signs of emergence from the vegetative state to the MCS. Fleeting behaviors may even have to be tabulated over time and calculated in a miniature experiment, a method developed by <a href="http://www.mossrehab.com/content/view/8925/188/">John Whyte</a> at Moss Rehabilitation Research Institute. </p>
<p>Seven years after doctors first defined the minimally conscious state, which is 10 times as prevalent as the more recognized vegetative state, it still lacks an <a href="http://www.who.int/classifications/icd/en/">international classification of diseases</a> code from the World Health Organization, making it essentially invisible in modern health care. In 2007, an Institute of Medicine panel identified the need for a study to gather basic data like how many MCS patients there are and where they live, but the institute couldn't raise the funding. These patients are not terminal, but doctors are ill-equipped to decide not only who will recover but to advise families on what the mental life of a person in MCS is like. Reports of dramatic &quot;<a href="http://www.theterrywallisfund.org/">awakenings</a>&quot; led to the discovery that neuroplasticity—structural growth in brain networks—can continue even 19 years after severe traumatic brain injury. Few living wills contain the possibility of a prolonged period in and out of awareness, and many families are tormented by how long they should wait before withdrawing care, typically done by stopping tube feeds. </p>
<p>Whyte is trying to make sense of the paradoxical vegetative patients who perk up with Ambien—in some cases, dosing the sleeping drug bumps vegetative patients into MCS or higher states. <a href="http://www.time.com/time/specials/2007/article/0,28804,1733748_1733754_1735853,00.html">Nicholas Schiff</a>, a neurologist at Weill Cornell, has theorized that Ambien may shut down a deep brain structure called the globus pallidus that normally depresses the central thalamus, a blimp-shaped structure sitting atop the brain stem that acts as a relay station for diverse inputs from neurons across the brain as well as sensory information streaming in through the brain stem. Bilateral damage to the thalamus notoriously results in a permanent vegetative state. Schiff is testing his hypothesis by scanning the brains of Whyte's Ambien responders. </p>
<p>Schiff's theories have shown promise in the past. He's one of the players behind a dramatic trial of <a href="http://www.charlierose.com/view/interview/8627">deep brain stimulation</a> in 2007, which applied pacemaker stimulation, already used for Parkinson's and essential tremor, to an MCS patient's central thalamus. During rehabilitation, our therapists gave Joshua <a href="http://www.springerlink.com/content/m2t81t074815j277/">median nerve stimulation</a>, a poor-man's alternative to DBS; he withdrew and grimaced. His apparent discomfort was a good sign, but he was well short of regaining speech, which occurred in the DBS trial. </p>
<p>Now, Schiff and his international team, supported by a landmark $3.9 million grant from the <a href="http://www.jsmf.org/">James S. McDonnell Foundation</a>, are in a quest to accurately diagnose patients like Joshua. The grant recognizes that it's at least as important to find out if people are conscious as whether they're dead. And Schiff has assembled a consciousness dream team, including <a href="http://www.coma.ulg.ac.be/home/steven.html">Steven Laureys</a> at the University of Liege in Belgium and <a href="http://www.neuroscience.cam.ac.uk/directory/profile.php?adrian">Adrian Owen</a> of Cambridge, to make it happen. </p>
<p>In a 2006 <a href="http://www.sciencemag.org/cgi/content/abstract/313/5792/1402"><em>Science</em></a> <a href="http://www.sciencemag.org/cgi/content/abstract/313/5792/1402"> report</a>, Owen analyzed the real-time brain activity of a woman in a vegetative state five months after a vehicle accident. The 25-year-old, whose only response to the external world consisted of occasionally fixating on an object, was able to follow complex commands to imagine doing things like playing tennis or walking through the rooms of her home. Eleven months after her scan, the virtual tennis star began a visible recovery, and Owen has gone on to find similarly remarkable results in at least three more of the 40 patients he has studied to date.</p>
<p>Yet the collaborators' most revolutionary work may be in a cheaper, more portable technology than fMRI and other enormous, multimillion-dollar scanners that can't attach to an electric wheelchair. Andrea K&uuml;bler <a href="http://www.ncbi.nlm.nih.gov/pubmed/16186045">first described</a> the concept of using brain-computer interfacing, driven by the brain's EEG waves, to diagnose patients with disorders of consciousness. </p>
<p>They're great for detecting seizures and sleep, but what can an EEG tell us about the brain's most significant function—consciousness? Until recently, the brain's analog wave seemed to pale in comparison with the diagnostic and prognostic powerhouse that is the heart's EKG. But digitally processing the EEG makes it possible to capture unique, reproducible signals—that's all you need to control a computer. Rudimentary commercial versions are entering the market—<a href="http://www.neurosky.com/products/force-trainer-march/">like one that will let you levitate a ball</a>. We'll find therapeutic uses for these brainy toys almost as fast as the <a href="http://www.usatoday.com/tech/science/2008-02-08-wii-rehabilitation_N.htm">Wii</a>.</p>
<p>In November, Laureys' group <a href="http://www.neurology.org/cgi/content/abstract/71/20/1614">demonstrated</a> that, as K&uuml;bler predicted, some low-level MCS patients who could seemingly only visually fixate or track for brief periods were able to follow basic instructions. In this case, they counted familiar and unfamiliar names played randomly into headphones—enough to prove low-level awareness but not enough to communicate. But Laureys is about to open a new frontier for BCI as a diagnostic tool. Using the BCI protocol, Laureys says he has found that some clinically vegetative patients are conscious. </p>
<p>So far, every case of digitally uncloaked consciousness has occurred within six months from injury. Still, I can make out Joshua's thalami, such as they are, on his MRI. Do they need a jump-start? Could BCI help us guide cognitive therapy or tell us more about how he's responding to stimulants? Many doctors harbor a therapeutic nihilism about these patients, but this research should give us good reason to keep our minds open. Even as we talk, Joshua's mother administers a range of motion therapy to her son's outstretched arm. She wants his body to be ready if his mind comes back. </p>Thu, 23 Apr 2009 11:10:00 GMThttp://www.slate.com/articles/health_and_science/medical_examiner/2009/04/state_of_mind.htmlFord Vox2009-04-23T11:10:00ZNew research may help unlock vegetative and minimally conscious patients.Health and ScienceNew research may help unlock vegetative and minimally conscious patients.2216595Ford VoxMedical Examinerhttp://www.slate.com/id/2216595falsefalsefalseNew research may help unlock vegetative and minimally conscious patients.New research may help unlock vegetative and minimally conscious patients.Coma patient